Our series "Balance," about health, nutrition and exercise, has not yet addressed pregnancy until now. My co-host for the series, Jamie Baum, invited UAMS researcher Elisabet Borsheim to join us. Borsheim is a professor in the Department of Pediatrics at UAMS with a secondary appointment in the Department of Geriatrics. Among her research topics, how physical activity, nutrition and fitness can have an impact on pregnancy health. She says research has long shown physical activity is very important during pregnancy.
Borsheim: Now the research is more focused on dosages and duration, type of exercise, but it has repeatedly been shown that exercise has a lot of good benefits for the pregnant woman. And when it comes to many different outcomes: weight gain during pregnancy, regulation of blood sugar. Also a large benefit on mental health and other outcomes.
Kellams: And this is a wildly broad question, but I guess depending where you are in your term of pregnancy, the exercise might vary.
Borsheim: Yes, very much so. And of course, as you progress in pregnancy, some exercise can be harder to do. And there are some also safety rules to think about and not exercise where you can get like hit in the stomach and at risk for fall. So, but there are many other exercises you can do and you just adjust as the pregnancy progresses.
Baum: So what are there official recommendations? You know, like we have physical activity guidelines for Americans. Are there special guidelines for women who are pregnant?
Borsheim: The current recommendation is more on the minimum amount one should do, and that is 150 minutes of moderate exercise per week.
Baum: So similar to non-pregnant people.
Borsheim: Exactly. And spread out over at least three times a week. But it's recommended that one exercises every day. So 20 to 30 minutes every day is recommended and moderate intensity. There is a rule that is, or recommendation that is called a talk test, that one should be able to have a conversation, be able to talk some during exercise. If you can sing, then it's too light of an intensity.
Kellams: Ah, so not able to sing, but able to hold a conversation.
Borsheim: Exactly.
Baum: And so what type of exercises would be the moderate intensity exercises for pregnant women?
Borsheim: Spinning is one good alternative. Swimming. It's recommended both aerobic and resistance exercise. So also some weightlifting or resistance exercise is recommended. Walking, but brisk walking.
Kellams: Not singing.
Borsheim: Not singing when you walk. You can also do some running. One important point is what start level you are at. So a runner, for example, can continue at the level they are at once they get pregnant. So it's very individualized, and if you are a... You regularly exercise. When you get pregnant, you can, in general, continue.
Baum: There's also a lot of information on like metabolic programming, which is a big word, but it's basically, you know, what the mother does, like exercise or eating or exposures while pregnant, can also impact the offspring. So did you do a study or follow offspring of women who were exercising?
Borsheim: We have recently completed a large study at Arkansas Children's Nutrition Center called the Expecting Study, where we recruited women who were sedentary and also had obesity to what we call a randomized controlled trial. So they were randomized into either exercise during pregnancy or just follow regular standard of care.
And we followed the women throughout pregnancy. They came into our center several times a week, worked out with a physical trainer, and also then coached to increase their steps outside of those training sessions. And we measured maternal outcomes and we are following the offspring, or the babies, as well.
And all of the babies have now turned 2 years of age. So we are now looking into what was mentioned here, more like the programming of also the offspring. And we will follow them. So we will have them come back when they are 5 years, 8 years, 11 years of age. And some of them are already 5 and 8 years. It was a study that went on over many years.
But what we have seen from previous studies at Nutrition Center is that there is an increased risk, for example, of obesity in the offspring if mothers have obesity, and there's an increased risk at 2 years of age, although we don't really call it obesity, of course, but early life. Higher fat mass is also an increased risk for later life obesity status.
So we know that just by looking at obesity side of things, we expect that exercise can prevent some of that so-called programming. There are also what we call preclinical studies that have shown really beneficial effect of maternal exercise on offspring's metabolic, cardiometabolic health.
Kellams: You know what I just find so fascinating about the research you and your colleagues do, not just at UAMS, but anywhere, the time that you have to spend with these to, you know, get accurate readings and searches and then find other questions in that research.
Borsheim: That is true. It takes a long time from having the idea to getting the right grants and secure funding for the research, executing the research. First get permission, of course, from ethical committees and so on, and then execute the research, recruit participants, lead them through the studies, and then continued participation, then analyze samples and analyze the data and interpret it.
I will say also at the Arkansas Children's Nutrition Center, there are several large ongoing cohort studies, and the recruiters there, and the team there, deserve kudos.
Kellams: Yeah.
Borsheim: And to then get these participants to come back, and they have a very good relationship with the participants.
Baum: And I think it's also important to note that people don't often see, because all these years of work may be, you know, one paper that 20 other people may read. I mean, hopefully it's more than that. But pregnant women and children are a protected class within, like, safety and review committee. So they do have to go extra scrutiny to participate in research, especially with children, because you need the child's permission as long as well as the parent to make sure children aren't being coerced by the family to participate.
Kellams: Finally, you may not be able to answer that, but is there also research and study going into postpartum exercise?
Borsheim: There are research going into postpartum exercise, and currently not at our center, but it is something we are interested in following up on. But there, at other institutions, there is increased focus on this now because often, when we look at maternal and pregnancy exercise, when the baby is born, in many studies, there's more interest then in following the baby and the offspring, and mothers are sometimes forgotten a little bit once the birth has occurred. And it's a very important period as well.
We have done some studies at our center on nutrition during the lactation period and postpartum period. And there's studies that are led by Dr. Aline Andres on more Mediterranean diet. There are quite a lot of studies on the dietary impact on composition of the milk. So that's an area of high interest in the U.S. and around the world.
Baum: When I used to work for a baby food company, yes, millions went into breast milk research because they're interested also in creating a formula that mimics breast milk for women who aren't able to breastfeed.
Kellams: Well, thank you so much for coming in.
Borsheim: Thank you. Thank you so much for having me.
Kellams: Jamie, thank you as always.
Elisabet Borsheim is professor in the Department of Pediatrics at UAMS. My co-host for our series "Balance" is Jamie Baum. She's an associate professor in the University of Arkansas Department of Food Science and director of the Center for Human Nutrition at the UofA.
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